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PubMed1987

Supplier-induced demand for physiotherapy in the Netherlands.

Empirical studies of supplier-induced demand in health care have mostly concentrated on the analysis of physician behaviour. In this article, the focus is on the economic determinants of physiotherapist behaviour in The Netherlands. It is shown that relative prices work as strong incentives to alter the mix of services supplied, conform to the model of revenue maximization under a production constraint. However, the time-series analysis also gives some indication that this ability to influence the demand for their services to increase hourly income is not fully exploited. The latter finding is inconsistent with pure income maximization but rather points to a trade-off between loss of revenue and demand manipulation. The fact that the choice of therapy varies with the pressure on provider incomes does not cast some doubt on the appropriateness of the chosen patterns of treatment in terms of effectiveness.

Health Services Needs and Demand↗
PubMed1988

Obstetric care in The Netherlands: regional differentiation in home delivery.

In this paper attention is focused on home delivery in the Netherlands, which still accounts for 36% of the total number of births delivered. Compared to countries with a similar level of socio-economic development, home delivery plays an important role within Dutch obstetric care. To understand this unique situation, one needs to have insight into the organization and structure of Dutch obstetric care which is described in the first part of this paper. In the second part of this paper regional differentiation in the relative importance of home delivery is described. Finally regression analysis is used in order to explain the observed regional pattern. A brief abstract from the vast amount of Dutch literature on the discussion between advocates and adversaries of home delivery is included in an appendix.

Delivery, Obstetric↗
PubMed1989

Baseline health care for refugees in The Netherlands.

In the Netherlands there are some 20,000 refugees from different parts of the world (e.g. Vietnam, Latin America). Most of them have experienced a form of organized violence. The somatic and psychosocial complaints of the refugees are comparable to those of Dutch war victims. They are mostly of an aspecific kind and making a diagnosis can be difficult because of the culturally different presentation of ill being. In order to help general practitioners in making a diagnosis the Refugee Health Centre (CGV) has made a classification of complaints according to whether or not they have a specific cause. It is clear from the literature that there are different opinions about the causes of the somatic complaints. As far as the psychic complaints are concerned it is remarkable that in our pilot study (n = 135) only 6% of the examined refugees suffer from a classical picture of the post-traumatic stress disorder; in a number of cases the picture is limited to some components only. Psychosocial complaints of refugees are subdivided and described. The philosophy of the CGV-treatment is to give assistance as much as possible in the refugee's neighbourhood; so that the clinician(s) will become part of the refugee's new social network. Another very important aspect of the assistance given is preventing medicalization of psychological problems. The basis of help is a recognition of the problems and complaints of the refugee. The structure of the Dutch health care, built up in 'lines', is very often very confusing for a refugee; this confusion can cause communication difficulties between refugee and clinician. To develop methods of treatment, definition and registration of complaints and problems can be a first step.

Health Services Needs and Demand↗
PubMed1989

Employment of individuals with haemophilia in The Netherlands.

A study was performed to determine whether improvements in the treatment of haemophilia over the past 20 years have influenced the prospects of these patients in the labour market. Surveys on the medical and social situation of haemophiliacs in The Netherlands were carried out in 1972, 1978 and 1985. Most of the patients participated in these surveys. Trends in employment do not show either an increase in the number of employed haemophiliacs or a decrease in the number administratively defined as disabled. However, considering the influence of the economic recession on the position of the chronically sick on the labour market and the rise in the number administratively defined as disabled in the Dutch population, haemophiliacs perform well. Sick leave has decreased considerably. Although the employment rate for the group of haemophiliacs is lower than that for the general male population, the level of employment in relation to educational achievements is high and most of the employed do not feel limited in their daily job activities by the haemophilia. Physical mobility is a main factor influencing the employment status but other factors, such as the type of occupation or former occupation and prejudice against people with haemophilia, have to be considered.

Absenteeism↗
PubMed1991

Results of two methods to determine health expectancy in The Netherlands in 1981-1985.

Health expectancy is a measure providing summarizing information on mortality on one hand and morbidity and/or disability on the other hand. In this article health expectancy is determined with two approaches: method 1 leads to life expectancy free of disability at birth and at other ages; method 2 leads to life expectancy in good health. Results of the various calculations show that according to method 1 life expectancy free of disability at birth for men in the Netherlands was 58.8 years and for women 57.3 years (based on data from the period 1981-1985). Results of method 2 are different from method 1; life expectancy in good health for men was 58.9 years and for women 60.7 years. Results of both methods are compared with studies which have been carried out in other countries. The comparison shows that method 1 leads to results which deviate from the other studies while results of method 2 are to a large extent similar to the other studies. Reasons are given which explain why the results of method 1 deviate from the other studies. In spite of the fact that the two methods lead to different outcomes, the conclusion is drawn that the difference in health expectancy between men and women is much smaller than the difference in total life expectancy between men and women. The difference in total life expectancy by sex in the period 1981-1985 was 6.7 years.

Adolescent↗
PubMed1992

Socio-economic health differences in The Netherlands: a review of recent empirical findings.

Evidence on variation in the frequency of health problems between socio-economic groups in the Dutch population has accumulated rapidly in recent years. This paper presents a review of these recent data. It is clear now that a lower socio-economic status is associated with a higher frequency of a wide range of health problems. This negative association has consistently been found for the following health indicators: birth weight; adult body height; prevalence of health complaints; prevalence of many chronic conditions; prevalence of disability; incidence of long-term work incapacity; perceived general health; adult mortality. Inconsistent findings were reported for: children's body height; prevalence of some chronic conditions; incidence of sickness absence (short-term work incapacity); perinatal mortality. The magnitude of the differences varies from study to study, and possibly from health problem to health problem. In studies categorizing the study population in 3-6 hierarchically ordered socio-economic groups on the basis of either education or occupational status, the Relative Risks (of the lowest versus the highest socio-economic group) mostly lie between 1 and 2. Exceptions are prevalence of disability and incidence of long-term work incapacity where Relative Risks between 2 and 4 have been found. A direct comparison with data from other countries is problematic, but at first sight the differences as observed in the Netherlands seem to be of the same order of magnitude as those observed in other industrialized countries. Although most Relative Risks imply 'weak associations' from a technical-epidemiological point of view, the Population Attributable Risks are substantial (generally between 0.25 and 0.40), underlining the public health impact of socio-economic health differences. Information on trends in health inequalities over time is limited to children's body height and adult mortality. For children's body height a substantial decrease of inequalities was found between 1964-1966 and 1980. For adult mortality, on the other hand, there is (indirect) evidence of a widening of the mortality gap between the 1950s and the 1980s. The evidence on specific factors which are involved in the 'causal chain' between socio-economic status and health problems is rather limited at the moment. A negative association with socio-economic status has been reported for the following risk factors: smoking; obesity; a number of unfavourable material living conditions; a number of unfavourable physical working conditions; psychosocial stress; lack of social support; less adequate supply/use of health care.(ABSTRACT TRUNCATED AT 400 WORDS)

Absenteeism↗
PubMed1993

Determinants of regional differences in lung cancer mortality in The Netherlands.

Although regional differences in lung cancer mortality are likely to be attributable to regional differences in tobacco smoking, studies in various countries found only weak relationships. This paper aimed at explaining regional differences in lung cancer mortality in the Netherlands. In a first step, clues for the role of smoking were obtained from a detailed description of regional mortality differences. These differences were found to be strongly determined by cohort effects: they vary between birth cohorts, and have been stable for over 30 years. Regional mortality differences reflect a diffusion of the lung cancer epidemic from high-income regions to low-income regions. These findings are suggestive of a relationship with regional differences in trends in cigarette smoking. In a second step, by means of multiple regression analysis, mortality differences in 1980-84 were related to available data on cigarette smoking and two other possible risk factors: work in transport and manufacturing industry, and air contamination. The independent variables referred to the 1970s. Positive associations with various smoking measures were found for women, but for men the associations were weak or non-existent. Mortality differences among men 45-64 years were associated with work in transport and manufacturing industry. Strong associations with air contamination were found for men and women 65 years and older. Additional analysis showed that regional differences in lung cancer among old men were strongly associated with smoking in 1930, i.e. half a century before. Changes in the regional pattern of tobacco consumption between 1930 and 1970 explain why smoking in 1970 is not associated with mortality differences in the 1980s.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Social inequalities and health among children aged 10-11 in The Netherlands: causes and consequences.

Socioeconomic health differences (SEHD) are relatively small in childhood. In adolescence they almost seem to disappear and among young adults they re-emerge. This article deals with mechanisms that contribute to the emergence of health differences by studying a group of 10-11 year old children in The Netherlands (n = 908). The role of determinants of health in the relation between socioeconomic status and health (causation) is studied, as well as the influence of health on school performance (selection). Both causation and selection mechanisms prove to exist. Life style and life circumstances are unequally distributed among the socioeconomic groups and can (partly) explain the relation between socioeconomic status and health. The health of the children is related with school performance, which can be seen as health selection. This relation however was only found in the lowest socioeconomic groups. In the lowest socioeconomic groups less healthy children perform worse at school than healthy children. The unequal distribution of determinants of health and health selection in the educational career among children probably contribute to SEHD in adult life.

Child↗
PubMed1995

Health of migrants and migrant health policy, The Netherlands as an example.

In The Netherlands, as in many other countries, many studies have addressed the health situation of migrant groups. After a discussion on methodological pitfalls in migrant studies, the article reviews the most important results. The data show that there are differences in the health status and mortality patterns between migrant groups and the indigenous population. Most, but not all, of the differences are in disfavour of ethnic groups. Possible determinants of these differences are evident in socio/cultural, genetic and socio-economic factors. A model is presented that demonstrates the relation between these factors and health and disease. Implications for research and for health policy are discussed.

Adolescent↗
PubMed1985

A carcinogenicity study with mutagenic organic concentrates of drinking-water in the Netherlands.

The carcinogenicity in male and female Wistar SSP TOX rats of organic drinking-water concentrates that are positive in the Ames test was studied at three doses. The organic mutagenic concentrates were prepared weekly from drinking-water from one location in The Netherlands by adsorption onto XAD-4/8 resins and elution with dimethylsulphoxide. The organic concentrates in dimethylsulphoxide were mixed with non-mutagenic drinking-water before exposure of the rats. Dose levels were based on multiples of expected human exposure levels. For the calculation the average human daily intake of drinking-water was taken as 2 litres for a body weight of 70 kg. There was no significant increase in tumour induction when male Wistar SSP TOX rats were exposed for 106 wk to 4.5, 14 or 40 times the expected human exposure level and females to 7,22 or 68 times the human level. The development and types of tumours were similar in the treated and control groups. The numbers of animals with tumours and of animals that died as a result of tumours in the exposed groups did not differ significantly from those in the control groups. These results suggest that these organic mutagenic drinking-water concentrates did not contain very potent carcinogens in effective concentrations.

Animals↗
PubMed1990

Estimate of the maximal daily dietary intake of butylated hydroxyanisole and butylated hydroxytoluene in The Netherlands.

The daily dietary intake of the phenolic antioxidants butylated hydroxyanisole (BHA) and/or butylated hydroxytoluene (BHT) was estimated using data obtained from a nationwide dietary record survey carried out in The Netherlands in 1987/1988. The estimates were based on the fat content of selected food categories and their respective maximum permitted levels of BHA and/or BHT. The results indicate that it is unlikely that the current acceptable daily intake for BHA (0-0.05 mg/kg body weight) is surpassed, even in individuals with an extremely high caloric intake, except in extreme cases in 1-6-year-olds. However, it cannot be excluded that the acceptable daily intake for BHT (FAO/WHO: 0-0.125 mg/kg; EEC: 0-0.05 mg/kg) is exceeded in all age and sex groups, but particularly in children aged 1-6 years.

Age Factors↗
PubMed1995

Hantavirus nephropathy in The Netherlands: clinical, histopathological and epidemiological findings.

Until 1995, 39 cases of serologically confirmed hantavirusnephropathy in humans, caused by the Puumala type of Hantavirus, have been documented in the Netherlands. Thirty-two of these occurred in Twente, a small region in the eastern part of the country, in which the presence of Puumala-like Hantavirus in feral rodents has recently been demonstrated. Sixteen of the cases documented in humans occurred in 1993. Here we present an overview of clinical, histopathological and epidemiological findings of hantavirus infections. All the clinical and laboratory findings of the 39 documented cases were similar to those found in infections with the same virus in neighbouring countries. Complete recovery of renal function occurred in all patients. One patient developed a Guillain-Barré syndrome after having recovered from her renal failure. Histopathological examination of kidney biopsies collected from 13 of the patients in the acute stage, confirmed the presence of acute interstitial inflammation of differing severity in these individuals. A serological survey carried out amongst 4232 healthy blood donors in the endemic area showed a seroprevalence of 0.7%. This suggests that less severe or perhaps even subclinical infections occur.

Acute Kidney Injury↗
PubMed1996

The climacteric in The Netherlands: a review of Dutch studies on epidemiology, attitudes and use of hormone replacement therapy.

The climacteric has been the subject of research in the Netherlands for several decades. The incidence of climacteric symptoms has not changed since the pioneerwork of Jaszmann in 1967; nevertheless the number of contacts with a physician decreased by a factor of three during the 1970s and early 1980s. A rise in the number of contacts has occurred since 1987-1988 and nowadays the same number is reached as was 20 years ago. In 1970 psychopharmacons were the first choice of therapy. Nowadays 90% of the prescriptions for climacteric complaints are hormones. Twelve percent of women aged 45-60 years are current users of HRT. The mean duration of HRT use is only 7 months. The positive attitude of most women towards the climacteric is an explanation for this very short duration of use. Women receive their information on HRT use mainly through women's magazines and TV programmes and not through physicians. The determinants of longer duration of use are a positive attitude to treatment, younger age and the support of the GP. Physicians claim that they prescribe progestogens for 51% of oestrogen users, but the data give a figure of only 20% of prescription of progestogens with oestrogens. One explanation for this difference is the practice of many doctors to prescribe progestogens only once in 3 months.

Attitude↗
PubMed1996

Survey of the management of third stage of labour in The Netherlands.

UNLABELLED: The standard practice during the third stage of labour of Dutch midwives and obstetricians was elucidated by a questionnaire mailed to all Dutch midwives and obstetricians. Prophylactic oxytocics in the third stage are used as a routine by 55% of the obstetricians and only 10% of the midwives. Oxytocin is the drug of first choice. CONCLUSION: Routine use of prophylactic oxytocics in the third stage is not the standard practice in the Netherlands. Obstetricians are much more likely to use prophylaxis than midwives.

Female↗
PubMed1983

The effects of the use of the morantel sustained release bolus system on calves grazing a highly contaminated pasture in The Netherlands.

The efficacy of the morantel sustained release bolus system for the control of parasitic gastroenteritis in calves was evaluated in the Netherlands. The effect of bolus administration to calves, either on May 1 at the beginning of the summer grazing season or on June 12 after the pasture was mown for silage, was determined in respect of liveweight gain, faecal worm egg output, serum pepsinogen values and worm burdens. In addition, pairs of tracer calves were turned out with each group every four weeks and sacrificed for worm counts in order to monitor pasture larval contamination throughout the grazing period. Compared with nontreated control calves, the worm egg outputs of the bolus-treated calves turned out (Nematodirus helvetianus), while the bolus-treated calves turned out on June 12 had a corresponding reduction of 95 and 100 percent. Over the grazing season the average weight gain of bolus-treated calves turned out on May 1 was 34 kg more than nontreated controls turned out at the same time. Difference in weight gain of the treated and control calves turned out late in the season was 10.5 kg in favour of the treated group. The postmortem worm counts were highest in the control calves turned out early and lowest in the bolus-treated calves turned out late. All tracer calves placed on the paddock grazed by control calves (turned out early) died from parasitic gastroenteritis from July onwards while those from the paddock grazed by the control calves (turned out late) died from parasitic gastroenteritis from September onwards. All the tracer calves placed on the paddocks grazed by bolus-treated calves survived until the intended slaughter date.

Animals↗
PubMed1987

Strains of cattle parasites in the Netherlands with different propensities for inhibited development.

A field study was undertaken of the possible differences in propensity for inhibited development in strains of cattle nematodes from two different locations in The Netherlands. In one location (Lelystad) the strains were thought to lack the ability for inhibited development as a result of environmental stimuli on the infective larvae, while in the other location (Utrecht) this ability was presumed to be present. The Lelystad strains were kept at the original location and were also transferred to a pasture in Utrecht, while the Utrecht strains remained in Utrecht. At both locations all permanent grazing calves showed high proportions of inhibited early fourth stage larvae of Ostertagia ostertagi, the proportion of the Utrecht strain being higher than the local and the transferred Lelystad strain. For Cooperia oncophora and Nematodirus helvetianus no clear differences between locations were observed in the permanently grazed calves. No inhibition occurred in tracer calves turned out in August in either location, but differences were seen among tracer calves turned out in October. The Lelystad strains, kept in Lelystad or transferred to Utrecht, showed no inhibition, while in the tracer calves grazed on pastures contaminated by the Utrecht strains a marked inhibition of O. ostertagi and N. helvetianus was observed. The Lelystad strains appear to lack the ability, possessed by the Utrecht strains, to inhibit their development in autumn in response to environmental stimuli.

Abomasum↗
PubMed1996

Residual effect of injectable moxidectin against lungworm and gastrointestinal nematodes in calves exposed to high pasture infectivity levels in the Netherlands.

The residual effect of a 0.2 mg kg-1 injectable formulation of moxidectin against lungworm and gastrointestinal nematodes in cattle was studied in a grazing experiment in the Netherlands. Five groups of four calves were grazed between May and October 1991 and one similar group was used as permanently housed control group for the evaluation of the development of immunity against lungworm by challenge infections with 5000 larvae of all six groups. The main parameter used to determine the residual effect for lungworm was faecal larval counts. Additional information was derived from pasture larval counts, enzyme-linked immunosorbent assay (ELISA), respiration frequency, coughing score and, particularly for evaluating development of immunity, worm counts. For gastrointestinal nematode infections faecal egg counts and larval differentiation of faecal cultures were the main parameters used. Pasture larval counts and an ELISA for Ostertagia and Cooperia were used as additional parameters. In three treated groups lungworm larvae (re)appeared in the faeces after 67, 95 and 119 days, respectively. This implies that a 100% residual effect did not last longer than 67-21 = 46 days. The treated group with patency starting on Day 95 was exposed to extremely high infection pressure and the ELISA indicated some host-parasite interactions from 2-4 weeks after treatment. Thus some interaction between moxidectin treatment and high infection pressure delayed the onset of patency in comparison to another treated group under much lower infection pressure. In all treated groups, including the one under high infection pressure, lungworm disease was prevented and the worm counts demonstrated development of immunity. In contrast, severe lungworm disease occurred in two control groups grazing together with the 'high infection pressure' treated group. The faecal egg counts and differentiation of larvae from faecal cultures demonstrated a 100% residual effect of at least 3 weeks and indicated a high residual effect of approximately 5 weeks against Ostertagia. Moxidectin suppressed Cooperia faecal egg counts for over 98% and the results indicated a more than 95% residual effect on faecal egg output during 2-3 weeks. The ELISA results were indicative for a delay of 2 weeks in the acquisition of gastrointestinal nematode infections following moxidectin treatment.

Animal Feed↗